Methods, systems, and devices relating to robotic surgical devices, end effectors, and controllers

ABSTRACT

The various embodiments disclosed herein relate to improved robotic surgical systems, including robotic surgical devices having improved arm components and/or biometric sensors, contact detection systems for robotic surgical devices, gross positioning systems and devices for use in robotic surgical systems, and improved external controllers and consoles.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims priority as a continuation of U.S. Pat. No.9,743,987, entitled “Methods, Systems, and Devices Relating to RoboticSurgical Devices, End Effectors, and Controllers,” which issued on Aug.29, 2017; which claims priority to U.S. patent application Ser. No.61/782,413, filed on Mar. 14, 2013 and entitled “Methods, Systems, andDevices Relating to Robotic Surgical Devices, End Effectors, andControllers,” both of which are hereby incorporated herein by referencein their entireties.

GOVERNMENT SUPPORT

This invention was made with government support under Grant No.DGE-10410000 awarded by the National Science Foundation: Grant Nos.NNX09AO71A and NNX10AJ26G awarded by the National Aeronautics and SpaceAdministration: and Grant No. WSIXWF-09-2-0185 awarded by U.S. ArmyMedical Research and Materiel Command within the Department of Defense.The government has certain rights in the invention.

FIELD OF THE INVENTION

The various embodiments disclosed herein relate to improved roboticsurgical systems, including improvements to various components therein.

BACKGROUND OF THE INVENTION

Various robotic surgical tools have been developed to perform certainprocedures inside a target cavity of a patient. These robotic systemsare intended to replace the standard laparoscopic tools and proceduresthat involve the insertion of long surgical tools through trocarspositioned through incisions in the patient such that the surgical toolsextend into the target cavity and allow the surgeon to perform aprocedure using the long tools. As these systems are developed, variousnew components are developed to further improve the operation andeffectiveness of these systems.

There is a need in the art for improved robotic surgical systems,including improved robotic devices and arm components, externalcontrollers, and positioning systems.

BRIEF SUMMARY OF THE INVENTION

Discussed herein are various improvements for robotic surgical systems,including robotic surgical devices having improved arm components and/orbiometric sensors, contact detection systems for robotic surgicaldevices, gross positioning systems and devices for use in roboticsurgical systems, and improved external controllers and consoles.

In Example 1, a gross positioning system for use with a robotic surgicaldevice comprises a base, a body operably coupled to the base, a firstarm link operably coupled to the body at a first rotational joint, asecond arm link operably coupled to the first arm link at a secondrotational joint, and an extendable third arm link operably coupled tothe second arm link. A portion of the third arm link is rotatable abouta third rotational joint, and the third arm link comprises a connectioncomponent at a distal end of the third arm link. Further, the connectioncomponent is configured to be coupleable to the robotic surgical device.

Example 2 relates to the gross positioning system according to Example1, wherein an axis of rotation of the first rotational joint isperpendicular to at least one of an axis of rotation of the secondrotational joint and an axis of rotation of the third rotational joint.

Example 3 relates to the gross positioning system according to Example1, wherein an axis of rotation of the second rotational joint isperpendicular to at least one of an axis of rotation of the firstrotational joint and an axis of rotation of the third rotational joint.

Example 4 relates to the gross positioning system according to Example1, wherein an axis of rotation of the third rotational joint isperpendicular to at least one of an axis of rotation of the firstrotational joint and an axis of rotation of the second rotational joint.

Example 5 relates to the gross positioning system according to Example1, wherein an axis of rotation of the first rotational joint, an axis ofrotation of the second rotational joint, and an axis of rotation of thethird rotational joint intersect at a spherical joint.

Example 6 relates to the gross positioning system according to Example1, wherein the extendable third arm link comprises an extender body andan extendable rod slidably coupled to the extender body, wherein theextendable rod is configured to move between an extended position and aretracted position.

Example 7 relates to the gross positioning system according to Example1, wherein the robotic surgical device comprises at least one arm,wherein the gross positioning system and robotic surgical device areconfigured to operate together to position the robotic surgical devicewithin a body cavity of a patient.

In Example 8, a arm component for a robotic device configured to bepositioned within a cavity of a patient comprises an arm body, a grasperend effector disposed at a distal end of the arm body, a first actuatoroperably coupled to the grasper end effector, and a second actuatoroperably coupled to the grasper end effector. The grasper end effectorcomprises an open configuration and a closed configuration. The firstactuator is configured to actuate the grasper end effector to rotate.The second actuator is configured to actuate the grasper end effector tomove between the open and closed configurations.

Example 9 relates to the arm component according to Example 8, furthercomprising a yoke operably coupled to the grasper end effector and adrive rod slidably disposed within the lumen of the yoke. The yokecomprises a lumen defined within the yoke, wherein the yoke is operablycoupled at a proximal end to the first actuator, wherein the firstactuator is configured to actuate the yoke to rotate. The drive rod isoperably coupled at a distal end to the grasper end effector and at aproximal end to the second actuator, wherein the second actuator isconfigured to actuate the drive rod to slide between a distal andproximal position.

Example 10 relates to the arm component according to Example 9, whereinthe second actuator comprises a hydraulic actuator.

Example 11 relates to the arm component according to Example 10, whereinthe hydraulic actuator comprises an input port defined in the hydraulicactuator, and a piston rod slidably disposed within the hydraulicactuator. The piston rod is operably coupled to the drive rod and isconfigured to slide proximally when hydraulic fluid is added to thehydraulic actuator through the input port, thereby urging the drive rodproximally.

Example 12 relates to the arm component according to Example 9, whereinthe second actuator comprises a pneumatic actuator.

Example 13 relates to the arm component according to Example 9, whereinthe second actuator comprises a shape memory alloy (“SMA”) actuator.

Example 14 relates to the arm component according to Example 13, whereinthe SMA actuator comprises a distal end component and a proximal endcomponent, at least one elongate SMA component disposed within the SMAactuator, and a tensioned spring disposed within a lumen defined in theSMA actuator. The at least one elongate SMA component is operaby coupledto the distal and proximal end components. The SMA component isconfigured to contract due to application of heat and thereby urge thedistal component toward the proximal component, thereby urging the driverod in a proximal direction.

Example 15 relates to the arm component according to Example 14, whereinthe distal component is configured to move in a distal direction whenthe SMA component is allowed to contract due to removal of the heat,whereby the tensioned spring is configured to urge the distal componentin a distal direction, thereby urging the drive rod in a distaldirection.

In Example 16, a robotic surgical system comprises a console, aprocessor operably coupled to the console, a first software applicationoperably coupled to the processor, and a robotic surgical deviceconfigured to be positioned into a body cavity of a patient. The consolecomprises a configurable user interface that comprises a visual displayof the target surgical space, at least one overlay disposed on the userinterface, and at least one deployable menu configured to appear on theuser interface upon command. The at least one overlay is configured toprovide information about a surgical procedure being performed. Thesoftware application is configured to generate the at least one overlayand the at least one deployable menu on the user interface.

Example 17 relates to the robotic surgical system according to Example16, further comprising a second software application configured toprovide feedback relating to a surgical performance of the user.

Example 18 relates to the robotic surgical system according to Example16, further comprising a second software application configured togenerate warm-up or practice exercises at the console for the user.

Example 19 relates to the robotic surgical system according to Example16, further comprising at least one biometric sensor disposed on theconsole, and a second software application configured to utilize thebiometric information to track the physiological state of the user. Theat least one biometric sensor is configured to collect biometricinformation relating to a user.

Example 20 relates to the robotic surgical system according to Example16, wherein the first software application is further configured toprovide personalized settings for each unique user upon identificationof the unique user.

While multiple embodiments are disclosed, still other embodiments of thepresent invention will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the invention. As will be realized, theinvention is capable of modifications in various obvious aspects, allwithout departing from the spirit and scope of the present invention.Accordingly, the drawings and detailed description are to be regarded asillustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of a robotic arm component having ahydraulic actuator, according to one embodiment.

FIG. 1B is a perspective view of certain internal components of therobotic arm component of FIG. 1A.

FIG. 10 is a side view of certain internal components of the robotic armcomponent of FIG. 1A.

FIG. 2A is an exploded perspective view of the robotic arm component ofFIG. 1A.

FIG. 2B is an exploded side view of the robotic arm component of FIG.1A.

FIG. 3 is an expanded perspective view of a portion of the robotic armcomponent of FIG. 1A.

FIG. 4 is an expanded perspective view of a portion of the robotic armcomponent of FIG. 1A.

FIG. 5A is an expanded perspective view of certain internal componentsof the robotic arm component of FIG. 1A.

FIG. 5B is an expanded side view of the internal components of therobotic arm component of FIG. 5A.

FIG. 6 is an expanded perspective view of a portion of the robotic armcomponent of FIG. 1A.

FIG. 7A is a perspective view of a robotic arm component having a shapememory alloy actuator, according to one embodiment.

FIG. 7B is a side view of the robotic arm component of FIG. 7A.

FIG. 7C is a cross-sectional view of a portion of the robotic armcomponent of FIG. 7A.

FIG. 8A is a cross-sectional perspective view of a portion of therobotic arm component of FIG. 7A.

FIG. 8B is a cross-sectional side view of the portion of the robotic armcomponent of FIG. 8A.

FIG. 8C is an expanded cross-sectional perspective view of a smallerportion of the robotic arm component of FIG. 8A.

FIG. 8D is an expanded cross-sectional perspective view of anothersmaller portion of the robotic arm component of FIG. 8A.

FIG. 9 is a perspective view of a portion of the robotic arm componentof FIG. 7A.

FIG. 10 is a perspective view of robotic surgical device with a contactdetection system, according to one embodiment.

FIG. 11 is a schematic view of a contact detection system, according toone embodiment.

FIG. 12 is a perspective view of a portion of the robotic surgicaldevice of FIG. 10.

FIG. 13 is a perspective view of robotic surgical device with apressurization system to maintain a fluidic seal, according to oneembodiment.

FIG. 14A is a perspective view of an external gross positioning system,according to one embodiment.

FIG. 14B is a further perspective view of the external gross positioningsystem of FIG. 14A.

FIG. 15 is a perspective view of a standard surgical table.

FIG. 16A is a schematic depiction of a user interface for a roboticsurgical system, according to one embodiment.

FIG. 16B is a schematic depiction of a menu that can be displayed on theuser interface of FIG. 16A.

FIG. 17 is a schematic depiction of a personalized display for a roboticsurgical system, according to one embodiment.

FIG. 18 shows two graphs showing the endpoint positions of roboticsurgical tools operated by two different surgeons, wherein the endpointpositions were tracked during a peg transfer test.

FIG. 19 is a perspective view of a console having at least one biometricsensor, according to one embodiment.

FIG. 20 is a perspective view of a controller for a robotic surgicalsystem, according to another embodiment.

FIG. 21 is a perspective view of a foot controller for a roboticsurgical system, according to one embodiment.

FIG. 22 is a perspective view of a handheld controller with a scrollwheel for a robotic surgical system, according to one embodiment.

FIG. 23 is a perspective view of a standard mouse controller.

FIG. 24 is a perspective view of a robotic surgical device having atleast one biometric sensor, according to one embodiment.

DETAILED DESCRIPTION

FIGS. 1A-10 depict a forearm 10 having a hydraulic actuator 16,according to one embodiment. The forearm 10 has a body 12 that encasesthe internal components, including, as best shown in FIGS. 1B and 10, amotor 14 and a hydraulic actuator 16 (in this case, a piston 16) thatare positioned within the body 12. In this embodiment, the end effector18 at the distal end of the forearm 10 is a grasper 18. In addition, theforearm 10 also has a coupling component 20 at its proximal end that isconfigured to be coupleable to an upper arm (not shown) of a roboticsurgical device.

In accordance with one implementation, a hydraulic actuator such as thehydraulic piston 16 in FIGS. 1A-10 can provide increased speed and forcecharacteristics for the end effector in comparison to other types ofactuators while also reducing the size requirements for the forearm. Insome aspects, the increased speed and force and decreased size can beaccomplished because the hydraulic actuator allows for direct linearactuation of the end effector, in contrast with threaded actuators thatoften require multiple gears in order to convert the rotary motion ofthe motor into linear motion.

As shown in FIGS. 2A and 2B, according to one embodiment, the body 12 ismade up of three body components 12A, 12B, 12C (also referred to hereinas “shell components”) that are configured to be coupled together tomake up the body 12 (also referred to as a “shell”): a first bodycomponent 12A, a second body component 12B, and a cap component 12C. Inthe embodiment as shown, the first and second body components 12A, 12Bis formed or configured to have form-fitting inner configurations asshown such that the motor 14 and the hydraulic piston 16 and any otherinterior components mate with the inner configurations when positionedwithin the body 12. According to one specific implementation, the secondbody component 12B can be transparent, thereby allowing a user tovisually confirm operation of the internal components of the device. Inaccordance with one embodiment, the cap component 12C constrains thebearings and protects the gears during use.

In this embodiment, the coupling components 22 as best shown in FIGS. 2Aand 2B couple the three body components 12A, 12B, 12C together. Morespecifically, the coupling components 22 in this embodiment are screws22 that are positioned through one of the coupling components 12A, 12B,12C and into another, thereby coupling those components together.Alternatively, the coupling components 22 can be any known devices orcomponents for coupling two or more body components together.

As best shown in FIG. 2A, the motor 14 has a drive shaft 24 at itsdistal end that is operably coupled to a motor gear 26 that is rotatedby the motor 14 when the motor 14 is actuated. As will be explained indetail below, the actuation of the motor 14 causes the end effector 18to rotate. Further, in this embodiment, the hydraulic piston 16 is asingle acting piston having an input port 28 (also referred to as an“input barb”) formed or positioned along a side of the piston 16 (asbest shown in FIGS. 1B, 1C, and 4) and a spring 40 positioned at aproximal end of the piston 16 (as best shown in FIG. 2B). In oneembodiment, the input port 28 is configured to be coupleable tohydraulic tubing (not shown) that is configured to provide the hydraulicfluid to the piston 16. As best shown in FIG. 4, in certainimplementations the port 28 extends out of the body 12 through a hole 30defined in the body 12.

As best shown in FIGS. 2A, 5A, and 5B, the piston 16 is coupled to theend effector 18. In this particular embodiment, actuation of the piston16 causes the grasper 18 to move between its open and closed positions.The piston 16 has a piston rod 32 extending from the distal end of thepiston 16 with a threaded drive rod 34 coupled to and extending from thepiston rod 32. The threaded drive rod 34 is threadably coupled at itsdistal end to a coupler 36 which, in turn, is coupled to a distal driverod 38 that is operably coupled to the grasper arms 18. In oneimplementation, the coupler 36 rigidly connects the two componentsthrough the use of an adhesive such as, for example, a thread lockingcompound. In one specific example, the adhesive is one of thethreadlocker products commercially available from Loctite®. Regardless,the adhesive retains the coupler 36 in place in relation to the threadeddrive rod 34 and distal drive rod 38 such that rotation is transferredthrough the coupler 36 rather than unscrewing one end or the other.According to one embodiment, the coupler 36 is sized to slidably fitwithin the bearing 46 as described in further detail below, therebyhelping to keep the overall length of the forearm short. Alternatively,the coupler 36 need not be sized to fit within the bearing 46.Regardless, actuation of the piston 16 can actuate the grasper arms 18to open and close.

FIG. 3 depicts the proximal end of the forearm body 12 and the couplingcomponent 20. It is understood that the coupling component 20 can be anyknown device or component for rigidly coupling one portion of a medicaldevice to another at a joint, and is specific to the upper arm (notshown) to which the forearm body 12 is being coupled. In thisembodiment, the coupling component 20 is a rectangular protrusion 20having a retention bolt 50 disposed within the square opening 52 definedwithin the protrusion 20. In accordance with one implementation, theprotrusion 20 is formed at the proximal end of the first body component12A such that rigidity may be maintained from the coupling component 20to the end effector 18.

In use, the piston 16 operates as follows, according to one embodiment.It is understood that, according to certain implementations, the grasper18 operates in the same fashion as many known graspers, with the distaldrive rod 38 slidably positioned within a lumen (not shown) defined inthe yoke 44 such that rod 38 (which is operably coupled to the arms ofthe grasper 18) can actuate the grasper to move between its open andclosed configurations by sliding the rod 38 distally and proximally inrelation to the yoke 44. To actuate this grasper 18 or any other knowngrasper requiring lateral actuation, fluid is added to the piston 16through the port 28, which is best shown in FIGS. 1A, 1B, 10, and 4.Referring specifically to FIG. 4, the port 28 is positioned along thepiston 16 such that the increased pressure causes the piston rod 32 tomove proximally (back into the piston body 16). This movement of the rod32 pulls the threaded drive rod 34 and the coupler 36 in a proximaldirection, thereby pulling the distal drive rod 38 proximally as well,thereby causing the grasper arms 18 to move toward the closed position.To actuate the grasper arms 18 toward the open position, the pressure inthe piston 16 is reduced, thereby allowing the spring 40 to urge thepiston 16 in the distal direction, thereby urging the piston rod 32, thethreaded drive rod 34, the coupler 36, and the distal drive rod 38distally and thus urging the grasper arms 18 toward the open position.

In one embodiment, the piston 16 is a single-action piston 16 with theport 28 positioned such that increased pressure causes the piston rod 32to move proximally as described above. This configuration eliminates theneed for an excessively strong fluid vacuum to move the pistonproximally. A piston that requires such a strong vacuum can haveproblems if any air leaks into the system and can lead to more airentering the fluid tract.

In one embodiment, the fluid provided to the piston 16 through the port28 is provided by a driving mechanism (not shown). The driving mechanismcan be any known device or component that can be coupled to the port andthereby provide fluid to the piston 16 at varying levels of pressure.According to one implementation, the driver can also be configured tosense the applied pressure and regulate the pressure in the piston 16 todrive the end effector 18 motion based on force at the end effector 18rather than position of the end effector.

In accordance with one implementation, the fluid in the hydraulic systemcan be water, saline, or any other known biosafe noncompressible fluid.

Alternatively, the piston 16 can be a dual acting piston that canprovide better control of the position and performance of the piston.

In the embodiment as shown, the end effector 18 can also be rotated viathe motor 14. That is, as mentioned above, the motor 14 can be actuatedto cause the end effector 18 to rotate. As best shown in FIGS. 2A and2B, the motor 14 rotates the motor shaft 24, which rotates the motorgear 26, which, in turn, rotates the driven gear 42. The driven gear 42is rotationally coupled to the end effector 18 such that rotation of thedriven gear 42 causes rotation of the end effector 18. Morespecifically, the driven gear 42 is coupled to the yoke 44 such thatrotation of the drive gear 42 causes rotation of the yoke 44. In oneembodiment, the gear ratio of the motor gear 26 and the driven gear 42can be changed to provide different performance characteristics of theend effector 18 roll axis.

The rotation by the motor 14 as described above is decoupled from thepush/pull motion of the piston rod 32. That is, the components that areused to cause the rotation and the push/pull motion are configured suchthat the two actions are separate and independent from each other. Inthis embodiment, the decoupling results from the bearing 46 that isrotationally coupled to the driven gear 42 such that rotation of thedriven gear 42 causes the bearing 46 to rotate. The bearing 46 furtheris rotatably positioned over the coupler 36 and distal drive rod 38 suchthat the coupler and distal drive rod 38 are positioned through thebearing 46 and do not rotate when the bearing 46 rotates. Thus, thedistal drive rod 38 can move distally and proximally while the bearing46 rotates.

In one alternative embodiment, the hydraulic actuation can be replacedwith pneumatics, shape memory alloy, or some other linear actuationcomponent.

In accordance with an alternative implementation, a shape memory alloyis used to actuate the end effector. FIGS. 7A-9 depict a forearm 60having an end effector 62 that is actuated using a shape memory alloythat contracts upon heating.

As shown in FIGS. 7A-7C, the end effector 62 in this implementation is aset of graspers 62. The forearm 60 has a shape memory alloy (“SMA”)actuator 64 that is operably coupled to the graspers 62 such thatactuation of the SMA actuator 64 causes the graspers 62 to move betweenits open and closed positions. Further, the forearm 60 also has a motor66 that is operably coupled with the grasper 62 such that actuation ofthe motor 66 causes the grasper 62 to rotate. As best shown in FIGS. 7Band 7C, the motor 66 has a motor shaft 68 that is operably coupled to amotor gear 70. The motor gear 70 is operably coupled to a driven gear 72that is, in turn, operably coupled to the graspers 62.

According to one embodiment, the graspers 62 are identical orsubstantially similar to the graspers 18 described in detail above.Alternatively, any known grasper configuration or any other known endeffector can be used.

In one implementation, the forearm 60 has a gearbox 74 that is operablycoupled to motor 66, the motor gear 70, and the driven gear 72 such thatthe gearbox 74 is configured to maintain the relative position betweenthe motor gear 70 and the driven gear 72, thereby ensuring that themotor gear 70 will maintain a uniform contact distance with the drivengear 72. According to one embodiment, the gearbox 74 has a clampingfeature actuated through the tightening of a bolt 76. The tightening ofthe bolt 76 pulls the motor gear 70 and driven gear 72 together andfurther secures the motor 66, thereby helping to prevent rotation ortranslation of the motor 66 or any other components.

FIGS. 8A-8D are a set of cutaway figures depicting the SMA actuator 64according to one embodiment. The actuator 64 provides linear motion tomove the grasper 62 between its open and closed positions. According toone implementation, as best shown in FIG. 8B, the SMA actuator 64 hastwo SMA wires 82 that are configured to contract upon heating. As usedherein, the term “SMA wire” is intended to mean any elongate shapememory alloy component (also referred to as a “cord,” “rope,” or“braid”) that can be used with the SMA actuator 64 as disclosed orcontemplated herein. The actuator 64 also has a spring 84 positionedthrough a central lumen 100 of the actuator 64.

According to one embodiment, the SMA material used in the wires 82 isnitinol. Alternatively, the material is a copper-based SMA material or aferromagnetic shape-memory alloy (“FSMA”) material. In a furtheralternative, the material is a shape-memory polymer such as, forexample, a shape-memory plastic. In yet another alternative, theshape-memory material can be any known shape-memory material that can beused in a medical device. Further, alternative implementations of theactuator 64 can be made of any material or component that can change itsphysical structure in a repeatable and useful way.

As best shown in FIGS. 8A and 8B, the actuator 64 also has two endcomponents 88, 90 and a bolt 86 inserted into the proximal end of theactuator 64 such that the bolt is positioned within the central lumen100 and within the spring 84, thereby helping to constrain the spring 84within the actuator 64. The bolt 86 helps to retain the proximal endcomponent 88 in place. In one embodiment, each of the end components 88,90 is made up of two components (such as, for example, circuit boards)that are coupled together to make a single end component 88, 90. Thatis, as best shown in FIG. 8B, the proximal end component 88 has a firstend component 88A and a second end component 88B, while the distal endcomponent 90 has a first end component 90A and a second end component90B. Each of the end components 88, 90 has two openings 92, 94 definedwithin the component 88, 90, with each opening 92, 94 configured toreceive one of the SMA wires 82. In accordance with one implementation,each of the SMA wires 82 is configured to be formed into a knot 96 thathelps to couple the wires 82 to the end components 88, 90 in theopenings 92, 94 such that the wires 82 are fixedly coupled to the endcomponents 88, 90 while also maintaining an electrical connectionbetween the wires 82 and the end components 88, 90.

In one embodiment, with reference to one wire 82 being coupled to thedistal end component 90 (with the understanding that the same process isused for each opening 92, 94 in each end component 88, 90), the wire 82is positioned through the opening 94 and then a knot 96 is tied into thewire 82 and positioned between the first component 90A and the secondcomponent 90B of the distal end component 90. The knot tail is then fedthrough the opening of the second component 90B and an adhesive orfixative is used to fix the first and second components 90A, 90Btogether to form the distal end component 90, thereby capturing the knot96 within the end component 90.

In accordance with one implementation, each opening 94 has a conductivering around the opening 94 that helps to establish the electricalconnection with the wire 82 disposed through the opening 94. It isunderstood in the art that such rings are standard features of circuitboards.

Alternatively, the two end components 88, 90 can be any devices orcomponents that can retain the wires 82 in place while also providing anelectrical connection to the wires 82. Further, instead of a knot, anyknown attachment component or mechanism that secures the wire 82 to theend component 88, 90 while also maintaining an electrical connection canbe used.

According to one implementation, the actuator 64 also has four bolts orpins 98 positioned strategically within the actuator 64 such that thetwo SMA wires 82 can be positioned around the pins 98 as shown in FIG.8B. More specifically, the pins 98 are positioned such that each wire 82can be looped around the pins 98 in a fashion that increases the lengthof the wire 82 in the actuator 64 (in comparison to the length of thewire if there were no pins) while preventing the wires 82 fromcontacting each other and thus causing a short-circuit. The longer thewire 82, the greater the amount of force that can be created by theactuator 64. According to one embodiment in which a type of nitinol isused for the SMA wires 82, the nitinol wires 82 shortens in an amountequaling about 4% of its total length. In such an embodiment, the lengthof the wires 82 must be maximized using the pins 98 to loop the wires 82in order to achieve the amount of pull required for the actuator 64.Thus, if more force is required to ensure that the grasper 62 can bemoved between its open and closed positions, then the length of the wire82 within the actuator 64 can be increased by looping the wire 82 aroundthe pins 98 as shown, especially given the need to keep the overall sizeof the forearm and thus the actuator 64 as small as possible. Of course,the amount of force required, and thus the length of the wire 82 that isneeded, will vary based on the type of shape memory alloy that is usedfor the wire 82 and the type of end effector 62 that is used. In certainalternatives, a different SMA wire 82 or a different type of nitinol canbe used that has the capacity to contract more than the nitinol wires 82described above.

As best shown in FIG. 8D, the actuator 64, in one embodiment, also has anut 110 and a bearing 112. The nut 110 is configured to receive and bethreadably coupled to the drive rod 114 (as best shown in FIG. 8B) thatis operably coupled to the end effector 62. Alternatively, instead of anut, any other coupling component or mechanism can be used to couple theactuator 64 to the end effector 62. The bearing 112 is positioned todecouple the rotation of the end effector 62 (which is actuated by themotor 66 as discussed above) from the linear motion that is actuated bythe SMA actuator 64.

In accordance with one implementation, the wire 82 is designed to beable to withstand a certain minimum amount of pull force. Further, asshown in FIGS. 8A-8D, the actuator 64 has two wires 82 that are usedtogether to create the appropriate amount of total force for theactuator 64. Alternatively, three or more wires 82 could be incorporatedinto the actuator 64 to provide additional actuation force. In a furtheralternative, two or more wires 82 could be braided together intobundles.

In one embodiment, the wire 82 is actually a braided wire 82 having fourbraided strands. According to one implementation, the four braidedstrands provide sufficient strength such that the appropriate amount offorce can be applied to the wire 82 without breaking the wire 82. Inaddition, the four strands in the wire 82 also make it possible toprovide two separate electrical loops, such that, for example, the powerpasses up strand one, down strand two, up strand three, and down strandfour.

FIG. 9 depicts an embodiment of an SMA actuator 64 having a couplingcomponent 116 disposed on an exterior portion of the actuator 64. In thespecific embodiment as shown, the coupling component 116 is a curvedprojection 116 configured to couple with the motor 66 discussed abovesuch that the motor 66 fits or “nests” within the concave portion of theprojection 116. The coupling component 116 prevents the rotationalactuation of the motor 66 from causing the motor 66 and actuator 64 torotate in relation to each other.

In use, according to one embodiment, the SMA wires 82 are actuated byapplying heat to the wires 82 via a known process in which an electricalcurrent is applied to the wires, which creates heat that causes thewires 82 to contract. The contraction of the wires 82 applies a pullingforce on the distal end component 90, thereby causing the component 90to be urged proximally, which causes the drive rod 114 (shown in FIG.8B) to retract (move in a proximal direction), thereby actuating thegrasper 62 to move between its closed and open positions. In oneembodiment, the retraction of the drive rod 114 causes the grasper tomove toward its closed position. Alternatively, any known process forapplying heat can be used.

When the grasper 62 needs to be actuated to move to the other position,the heat being applied to the SMA wires 82 is removed and the wires 82are allowed to cool. As they cool, they begin to expand and thuslengthen. The spring 84 within the actuator 64 is configured to providethe restoring force that urges the distal end component 90 in a distaldirection, thereby urging the drive rod 114 in the same direction andthus actuating the grasper 62 to move toward the other position. In oneimplementation, the urging of the drive rod 114 in the distal directioncauses the grasper to move toward its open position.

In accordance with one embodiment, the SMA actuator 64 has channelsdefined within the actuator that provide fluidic communication betweenthe interior and the exterior of the actuator 64, thereby allowingambient air to flow into the interior of the actuator 64 and intocontact with the SMA wires 82, thereby providing natural convectivecooling of the wires 82. Alternatively, active cooling can be provided,such as forced air or thermo-electric cooling (such as, for example,Peltier coolers, one version of which is commercially available fromBeijing Huimao Cooling Equipment Co., Ltd., located in Beijing, China)(not shown), both of which increases the amount or the speed of thecooling action in comparison to natural convective cooling.

Operation of a robotic device having moveable arms, and especiallymoveable arms with elbow joints, creates the risk that those arms or theelbows of those arms can contact the patient's cavity wall, potentiallycausing serious damage to the patient and/or the device. During aprocedure, a camera positioned on the device such that it is disposedbetween two arms has a viewpoint that does not capture the elbows,meaning that the user generally cannot detect or observe any contactbetween the arms and the cavity wall. One solution is a contactdetection system such as the exemplary embodiment depicted in FIG. 10.In this embodiment, a robotic device 120 has a device body 122, two arms124, 126 coupled to the body 122, and two contact detection sleeves 128,130 positioned over those arms 124, 126. According to certainembodiments, the sleeves 128, 130 also serve as sterilization sleevesthat help to maintain a sterile field for the robot arms 124, 126. Inanother implementation, as best shown in FIG. 11, the sleeves 128, 130are part of a contact detection system 138 that is made up of thesleeves 128, 130, a grounding pad 134 attached to the patient's skin,and at least one sensor 136 that is operably coupled to the sleeves 128,130 and the pad 134. More specifically, the sensor 136 is electricallycoupled to the sleeves 128, 130 via a wire 140 that extends from thesleeves 128, 130 to the sensor 136. Further, the sensor 136 iselectrically coupled to the pad 134 via wire or elongate member 142 thatextends from the sensor 136 to the pad 134. In addition, in oneembodiment in which one end effector is a monopolar cautery device, thepad 134 is also electrically coupled to a cautery generator (not shown)via wire or elongate member 144. That is, embodiments having a monopolarcautery device, the device requires a grounding pad (independent of anygrounding pad—such as pad 134—for the contact detection system). Thus,in one embodiment, the grounding pad 134 serves as a grounding pad notonly for the detection system 138, but also the monopolar cauterydevice. Alternatively, separate grounding pads are provided for thesystem 138 and the end effector. It is understood that the wires 140,142, 144 can also include a cord, an elongate member, or any otherelectrical connection component.

According to one embodiment, each of the contact detection sleeves 128,130 has contact sections (also referred to as “patches”) 132 (as bestshown in FIG. 10) that are made of a conductive material such as copperand positioned along an external portion of the sleeve 128, 130. Forexample, a contact section 132 made of copper is schematically depictedin FIG. 12. Alternatively, the material can be silver, aluminum, orgold. In a further alternative, the material can be any known conductivematerial that could be used in a contact detection system. In oneembodiment, the contact sections 132 are copper mesh patches 132. In oneimplementation as best shown in FIGS. 10 and 12, the patches 132 can bepositioned strategically along the sleeves 128, 130 at those areas ofthe arms 124, 126 that are most likely to make inadvertent contact withan interior wall or other portion of a patient's cavity. For example, asdepicted in FIG. 10, there are three patches 132 positioned along anexternal portion of each sleeve 128, 130, with one patch 132 positionednear each shoulder, one patch 132 at each elbow, and one patch 132 nearthe distal end of the forearm of each arm 124, 126. In another example,as shown in FIG. 11, the patch 132 is positioned at the elbow of therobotic arm. Alternatively, the patches 132 can be positioned at regularintervals across the exterior of each sleeve 128, 130. Alternatively,the patches 132 are distributed according to any other known pattern orstrategy for positioning the patches 132 on the sleeves 128, 130. In afurther alternative, the sleeves do not have patches. Instead, thesleeves—such as sleeves 128, 130—could be made up of two or more layersof material that can interact such that the sleeves themselves candetect contact and transmit a signal based on such contact (similar tothe way in which a touchscreen works). These patch-less sleeves alsoeliminate the need for a contact pad.

As shown in FIG. 11, the grounding pad 134, in one embodiment, ispositioned on the patient's lower back. The pad 134 is electricallyconnected to the contact sections 132 via the electrical wire discussedabove such that any contact between a contact section 132 and thepatient's body (including an internal cavity of the patient) creates aconductive path between the contact section 132 and the grounding pad134. If an electrical connection is made between the contact section 132and the grounding pad 134 via such a conductive path as a result ofcontact between the contact section 132 and the patient's internalcavity, the sensor (or sensors) 136 is triggered, thereby notifying thesurgeon or another user that contact has been made between one of therobotic arms and a wall of the patient's cavity. Alternatively, the pad134 can be positioned anywhere on the patient or in contact with thepatient so long as the pad 134 is electrically accessible through allparts of the patient. In one implementation, the grounding pad 134 is acommercially-available grounding pad used in monopolar electrocautery.

One specific embodiment of a contact patch 132 is schematically depictedin FIG. 12. In this embodiment, the sleeve 130 has this single contactpatch 132 positioned at or near the elbow of the robotic arm over whichthe sleeve 130 is positioned. Alternatively, the sleeve 130 can have twoor more patches 132 in any of a number of configurations. In variousother embodiments, the positioning of the one or more patches 132 candepend on the structure or configuration of the robotic arm (or otherportion of the robotic device) or the expected movements thereof.

In use, when one of the arms 124, 126 makes contact with the patient'scavity wall, the sleeve 128, 130 on that arm, and thus at least one ofthe contact patches 132 on that sleeve 128, 130, makes contact with thecavity wall, thereby completing an electrical circuit running throughthe patch 132, the grounding pad 134, and the at least one sensor 136such that the sensor 136 provides a notification to the user about thecontact between the arm 124, 126 and the cavity wall. In one embodiment,the extent of the contact can impact the extent of the notification orfeedback. That is, the harder the arm 124, 126 contacts the wall or thegreater the surface of the arm 124, 126 that contacts the wall, the morethe wall deforms and conforms to the shape of the arm 124, 126, thusincreasing the amount of surface of the sleeve 128, 130 that contactsthe wall. The increased contact surface of the sleeve 128, 130 triggersa stronger electrical connection, and the sensor 136 can be configuredto provide a greater or different notification based on the strongerelectrical connection. Alternatively, the location of the contact can beprovided in the notification or feedback. That is, each patch 132 can beuniquely identified according to any known fashion such that thenotification or feedback provides information not only about thecontact, but also information about the identity of the patch 132 atwhich the contact occurred. According to one embodiment, this system canhelp detect any collision or other contact between an arm and thepatient's cavity wall or an internal organ and thus help the user tobetter control the movements that are made using the robotic device. Thesensor's notification of the contact can help to prevent the user fromdoing further harm to the patient or the robotic device.

In a further embodiment, the sleeves 128, 130 can also be configured tobe electronic noise reduction sleeves 128, 130 (also referred to hereinas “Faraday sleeves”). More specifically, in certain embodiments, thesleeves 128, 130 are electronic noise reduction sleeves 128, 130 made atleast in part of a woven copper mesh. In at least one exemplaryimplementation, the sleeves 128, 130 are made entirely of a tightlywoven mesh made of copper and are grounded. Alternatively, the wovenmesh is made of any mesh made of any known conductive material. Forexample, alternative conductive materials include, but are not limitedto, silver, aluminum, and gold. The sleeves 128, 130, in addition toproviding a sterilized field for the robotic arms 124,126, can reduce orterminate the electronic interference (also referred to herein as“noise”) created by the multiple different electronic components in therobotic device, including, for example, motors and end effectors such ascautery components.

Another embodiment disclosed herein relates to improved methods anddevices for maintaining the sterilization of a robotic device such thatthe device can be reused. Robotic surgical devices such as the variousembodiments disclosed herein are exposed to many different body fluidsduring a procedure. In order to be able to reuse a surgical device, thedevice must be fairly impermeable to those fluids. While most componentsof the various robotic devices disclosed and contemplated herein arepositioned such that they generally do not contact any of the bodyfluids, the end effectors at the distal ends of the robotic arms are, bydesign, intentionally in contact with or even immersed in the fluids asthe end effectors are used to perform a procedure. Typically, mechanicalseals such as o-rings can be used to maintain the fluidic seal in therobotic devices contemplated herein. However, o-rings may not work aseffectively for certain end effectors.

FIG. 13 depicts one embodiment of a robotic device 150 that usespressurization to maintain a fluidic seal and thereby maintain thesterilization of the device 150. More specifically, the device 150 has abody 152 and two arms 154, 156 coupled to the body 152. Each of the arms154, 156 has an upper arm 154A, 156A and a forearm 154B, 156B. In thisembodiment, the device 150 also has at least one pressurization tube158, 160 associated with each arm 154, 156. More specifically, eachpressurization tube 158, 160 is operably coupled to a forearm 154B, 156Bsuch that the tube 158, 160 forces pressurized air into an interiorportion of the forearm 154B, 156B. It is understood that the term “tube”as used herein is intended to mean any tube, pipe, line, or any otherknown elongate member having a lumen that can be used to deliverpressurized air. In this embodiment, the interior portion of eachforearm 154B, 156B is fluidically sealed in relation to the air outsidethe forearms 154B, 156B except for the distal opening 166, 168 in theforearm 154B, 156B from which the end effector 162, 164 extends. Inaccordance with one implementation, the pressurization tubes 158, 160force pressurized air into the forearms 154B, 156B such that theirinterior portions have pressures that are higher than the air pressureinside the patient's cavity, thereby creating a constant flow of air outof the forearms 154B, 156B through the distal openings 166, 168.

In use, the pressurization tubes 158, 160 pressurize the interiorportions of the forearms 154B, 156B such that there is a constant flowof pressurized air out of the distal openings 166, 168 of the forearms154B, 156B. This constant flow from each forearm 154B, 156B operatesbased on the same principle as a clean room—the flow of air maintainsthe sterility of the interior portions of the forearms 154B, 156B bypreventing the fluids from accessing those interior portions. That is,the constant flow of air keeps any liquids outside the forearms 154B,156B from entering through those distal holes 166, 168.

FIGS. 14A and 14B depicts an external gross positioning device andsystem 180 that can be used to automatically grossly position a surgicaldevice 182 inside a cavity of a patient (as best shown in FIG. 14B,according to one embodiment. “Gross positioning,” as used herein, isintended to mean general positioning of an entire moveable surgicaldevice (in contrast to precise placement of the specific components ofsuch a device, such as an arm or end effector). In known roboticsurgical systems, the positioning of those devices during a surgicalprocedure can be a challenging task. Further, minimally invasivesurgical procedures (using either robotic or non-robotic systems)frequently require a surgical technician to reposition the surgicalequipment, such as a laparoscope. Such repositioning takes time andadditional effort. In addition, in some cases, the surgical technicianis a junior medical student who is not fully trained in laparoscopy. Asa result, the repositioning instructions from the surgeon often resultin an obstructed and/or fogged view of the surgical site, requiringadditional cognitive resources from the surgeon. Hence, the Da Vinci®system and known single incision surgical devices often require timelyrepositioning of the patient, the robotic system, or both whileperforming complicated procedures.

The various gross positioning devices contemplated herein aid in therepositioning of surgical devices (including, for example, any surgicaldevices that have a device body or rod configured to be positionedthrough an incision and at least one robotic arm coupled to the devicebody that is positioned entirely within the cavity of the patient)throughout the procedure without additional intervention from thesurgical staff. The gross positioning system embodiments are capable ofcontrolling the degrees of freedom, azimuth and elevation angle, androll and translation about the axis of insertion of laparascopicsurgical tools, including robotic laparoscopic surgical tools. As aresult, the gross positioning device embodiments disclosed andcontemplated herein can grossly position a surgical device through anincision into a patient cavity such as the abdominal cavity with highmanipulability, reducing the operative time and stress induced upon thesurgical staff. The combination of the external gross positioning systemwith the internal surgical device system will allow the degrees offreedom of the internal system to effectively increase withoutincreasing the size of the surgical robot/device.

In one implementation, the various devices described and contemplatedherein can be used with any single site surgical device with anavailable external positioning fixture, such as a protruding rod ormagnetic handle.

This system embodiment 180 has a base 184 and a body 186 coupled to thebase. An upper arm or first arm link 188 is rotatably coupled to thebody 186 at a rotational coupling or joint 190 such that the upper arm188 can rotate in relation to the body 186 around the axis 190A as bestshown in FIG. 14B. A forearm or second arm link 192 is rotatably coupledto the upper arm 188 at a rotational coupling or joint 194 such that theforearm 192 can rotate in relation to the upper arm 188 around the axis194A as best shown in FIG. 14B. The device 180 also has a third link orextender 198 (best shown in FIG. 14B) coupled to the forearm 192. Theextender 198, according to one embodiment, has two degrees of freedom:it can both rotate and extend laterally. That is, the extender 198 isconfigured to move between an extended position and a retracted positionand any position in between. In one embodiment, the amount of extensionand retraction is depicted by the arrow 204 in FIG. 14B. As shown inFIG. 14B, the extender 198 can have two components: a stationary body198B and an extendable rod 198C. In this embodiment, the extendable rod198C extends from and retracts into the stationary body 198B as shown.Further, the extender 198 can also rotate around axis 198A. Morespecifically, in the depicted embodiment, the body 198B and theextendable rod 198C are rotationally coupled to each other such thatthey both rotate around axis 198A together. Alternatively, theextendable rod 198C can rotate in relation to the stationary body 198Baround axis 198A while the stationary body 198B does not rotate.Alternatively, the extender 198 can be any known component or devicethat provides both extension and rotation as contemplated herein.

In one implementation, the base 184 is configured to keep the entiredevice 180 stable and secure during use. As shown, the base 184 is madeup of two extended pieces or “feet” 184A, 184B (best shown in FIG. 14A)that provide stability and help to prevent the device 180 from tiltingor tipping during use. In alternative embodiments, the base 184 can beany structure that provides such stability, including, for example, avery heavy or weighted structure that uses the weight to enhancestability. In certain implementations, the base can be stably coupled toa surgical table on which the patient is placed, such as the knownsurgical table 210 depicted in FIG. 15. According to one implementation,the base 184 can be coupled to a rail 212 on the table 210. In a furtheralternative, the base 184 can be coupled to any fixed object in theoperating room. Alternatively, the base 184 can be coupled to or be anintegral part of a cart or other mobile standalone unit.

In one embodiment, the rotational axis 190A at rotational joint 190(between the body 186 and the upper arm 188) is perpendicular to boththe rotational axis 194A at rotational joint 194 (between the upper arm188 and the forearm 192) and the rotational axis 198A. In other words,each axis 190A, 194A, 198A can be perpendicular in relation to the othertwo. The three axes 190A, 194A, 198A being perpendicular can, in someimplementations, simplify the control of the system 180 by causing eachaxis 190A, 194A, 198A to contribute solely to a single degree offreedom. For example, if the extender 198 is rotated around axis 198A,the tilt of the surgical device 182 does not change when all three axes190A, 194A, 198A are perpendicular. Similarly, if the upper arm 188 isrotated around axis 190A, only the tilt of the surgical device 182 fromside to side is affected. Alternatively, two of the three axes 190A,194A, 198A are perpendicular to each other. In a further alternative,none of the axes 190A, 194A, 198A are perpendicular to each other.

In one embodiment, the three axes 190A, 194A, 198A (as best shown inFIG. 14A) intersect at the intersection 200 (as best shown in FIG. 14B),also known as a “spherical joint” 200. The intersection 200 remainsfixed at the same location, regardless of the positioning of the armlinks 188, 192, 198, and can be used as the insertion point duringsurgeries. In one implementation, the intersection 200 causes the system180 to act similarly to a spherical mechanism. A “spherical mechanism”is a physical mechanism or software application that can cause all endeffector motions to pass through a single point, thereby allowing asurgical system to use long rigid tools that perform procedures throughincisions that serve as single pivot points. As an example, bothCOBRASurge and the Raven have mechanical spherical mechanisms, while DaVinci has a software-based spherical mechanism. In the device 180 asshown in FIG. 14A, the configuration of the device 180 creates thespherical joint 200 such that the extender 198 must pass through thesingle point of the spherical joint 200. The spherical joint 200 createdby the device 180 increases the size of the effective workspace(depicted by the cone 202) for the surgical device 182.′

Alternatively, the gross positioning device 180 can have a fourth link,a fifth link, or any number of additional links, and a relatedadditional number of rotational joints. Further, the device 80 can alsohave fewer than three links, and a related number of rotational joints.Thus, in one specific alternative implementation, the device 180 canhave solely a base (such as base 184), a body (such as body 186), and afirst link (such as first link 188) with a single rotational joint (suchas rotational joint 190). In sum, the gross positioning device 180 canhave a single rotational joint, two rotational joints, or any number ofrotational joints.

In use of the embodiment shown in FIGS. 14A and 14B, the arm links 188,192, 198 rotate about axes 190A, 194A, 198A to position the surgicaldevice 182 within the surgical space defined by the cone 202. The cone202 is a schematic representation of the outer boundaries of the spacein which the device 182 can be positioned by the positioning device 180.More specifically, the extender 198 can be rotated around axis 198A torotate the surgical device 182 about the axis 198A. Further, the armlinks 188, 192 in combination with the extender 198 can be used toarticulate the device 182 through two separate angular planes. That is,the two axes 190A and 194A can affect the angular position of theextender 198. In addition, the extender 198 can be extended or retractedto allow for the surgical device 182 to be advanced into and out of thepatient's body cavity.

In one implementation, the positioning system 180 and the surgicaldevice 182 (as shown in FIG. 14B) can be used in combination, such thatthe surgical device 182 is treated as an extension of the positioningsystem 180 wherein both are used together to move and operate thesurgical device 182. For example, the surgeon may want to move thesurgical device 182 a total of one inch to the right and thus actuatesan external controller to cause this move. The controller transmits theappropriate signals to the system 180 and the surgical device 182 suchthat the system 180 and device 182 work in combination to move thesurgical device 182 one inch to the right. In one example, the system180 could move 0.5 inches and the device 182 could move 0.5 inches,thereby resulting in the device 182 moving the full one inch as desired.According to one embodiment, the system 180 can thus be used to maximizethe strength, workspace, and maneuverability of the combination of thesystem 180 and the device 182 by determining the optimal contribution ofeach component during use.

Alternatively, the system 180 and the device 182 operate separately.That is, the system 180 is not operable or does not operate while thedevice 182 is being used, and the device 182 is not operable or does notoperate while the system 180 is being used. For example, if the device182 is being used and it is determined that a target object in thesurgical space is outside the reach of the device 182, the device 182 is“shut down,” otherwise rendered inoperable, or simply placed in a “pausemode,” and the system 180 is used to reposition the device 182accordingly.

It is understood that the device 180 can be operably coupled to aprocessor or computer (not shown) such that the processor can be used tocontrol the system 180, including movement of the arm links 188, 192,198 to grossly position the surgical device 182.

In alternative embodiments, the system 180 can have an arm that has only2 arm links, or in yet another alternative the arm can have only 1 armlink.

In a further alternative implementation, the system 180 can also beconfigured to incorporate or integrate equipment or devices that coupleto the surgical device 182 to provide various functionalities to thedevice 182. For example, in one embodiment, the positioning device 180can contain suction and irrigation equipment that couples tocorresponding equipment in the surgical device 182 such that thesurgical device 182 includes suction and irrigation components. Inanother example according to a further implementation, the positioningdevice 180 can contain any known equipment that is configured to coupleto corresponding equipment in the surgical device 182.

Alternative embodiments contemplated herein also include systems thatcan be used with surgical devices that are magnetically controlled (incontrast to the surgical device depicted in FIGS. 14A and 14B, which iscontrolled via a positioning rod inserted through the surgicalincision). In those implementations, the positioning system positionsthe surgical device anywhere along an internal surface inside thepatient's cavity by positioning an external magnetic component (such asa magnetic handle or other type of external magnetic component) alongthe outer skin of the patient. This positioning of the device caninclude any combination of movement in two dimensions along the surfaceof the patient's skin as well as rotation of the external magneticcomponent about an axis perpendicular to the surface of the skin. Ofcourse, it is understood that while the movement of the magneticcomponent along the skin of the patient is considered to be twodimensional, the patient's skin is curved such that movement of theexternal component along the skin demonstrates absolute manipulation inall six degrees of freedom.

Another set of embodiments disclosed herein relates to a user interfaceand related software applications for use in surgical robotics. FIG. 16Adepicts a user interface 280, according to one embodiment. The interface280 provides a visual display 282 of the surgical space as captured by acamera. In addition, the interface 280 can also provide additionalinformation via various icons or informational overlays positioned onthe interface 280 in any configuration chosen by the user. For example,in the user interface 280 depicted in FIG. 16A, the left arm statusoverlay 284 is positioned in the upper left hand corner of the interface280, while the right arm status overlay 286 is positioned in the upperright hand corner. Further, the device controller sensitivity overlay288 is positioned in the lower left hand corner, and the deviceconfiguration overlay 290 is positioned in the lower right hand corner.In addition, the cautery status overlay 292 is positioned in a middleportion of the lower edge of the display 282. The interface 280,according to one embodiment, is fully customizable such that the user(typically a surgeon) can actively arrange the icons or overlays on thedisplay 282 in any configuration that the user desires. In analternative embodiment, all of the informational overlays can bepositioned along one edge of the display 282.

In another implementation, the interface 280 can be triggered to displaya menu, such as, for example, the menu 294 as shown in FIG. 16B.According to one embodiment, the menu 294 can display and provide accessto various types of additional information. The menu 294 can betriggered by actuation of a button (not shown) that both freezes therobotic device and causes the display of the menu 294. Alternatively,the button can simply cause the display of the menu 294. In oneexemplary embodiment as shown in FIG. 16B, the additional information onthe menu 294 includes real-time patient information such as thepatient's current heart rate and blood pressure. Further, the menu 294can also provide access to historical patient information such asprevious conditions, X-ray images, and MRI images of the patient. Inaddition, the menu 294 can also provide additional information about thecurrent surgical procedure, such as the elapsed time in surgery.Further, the menu 294 can provide any other relevant or useful realtimeor historical information.

In use, before a surgical procedure begins, the surgeon can positiondifferent informational overlays or icons on the display 282 as thesurgeon desires. Further, the user can actuate a button on the userinterface 280 or operably coupled thereto at any time before, during, orafter a procedure to trigger the display of the menu 294. For example,the surgeon might notice something strange or unexpected during aprocedure and actuate the button to display the menu 294 in order toaccess the patient's current heart rate or blood pressure, for example.Alternatively, the surgeon might want to select a different camerafilter or different lighting during a procedure to better visualizecertain structures or areas of the surgical space. According to oneembodiment, the user interface 280 can act as an informational hub fordecision-making during the procedure and/or during emergencies thatmight occur during the procedure. The user interface 280 providesenhanced surgeon comfort and ergonomics in comparison to known consolesand interfaces for robotic surgical systems by allowing for easyreal-time adjustments to the display 282 to fit the needs of thesurgeon, technician, or other user.

In a further implementation, a display 282 accessible to and used bymultiple users over time (such as on a surgical system in an operatingroom in a hospital) can be configured to be quickly and easily set tothe personalized settings of a specific user. That is, a specific usercan configure the display 282 as desired at any time, including theplacement of the informational overlays and other configurable settingsof the display 282. That configuration of the display 282 can be savedand associated with the user's profile or account such that the user canaccess the configuration whenever the user accesses her or his accountwhile using the interface 280. In one embodiment, the interface 280allows for the saving of and access to the user personalized settingsthrough a personalized login in which each user must log in to theinterface 280 system each time the user wants to use it.

For example, the interface 280 can require a specific username andpassword for each user such that each time the user first interacts withthe interface 280, the display 282 launches a screen or overlay thatprompts the user to enter a username and password or any other type ofpersonalized login information. Only after the user enters the correctpersonalized login information is the interface 280 triggered to provideaccess to the user and further to configure the display 282 aspreviously configured by the user. One example of a personalizedconfiguration of a display 296 is shown in FIG. 17 for exemplarypurposes only. Alternatively, the interface 280 can be operably coupledto a card reader (not shown) such as an RFID or NFC reader such that theuser must swipe a personalized ID badge or card near or through the cardreader in order to access the interface 280. In a further alternative,the interface 280 can be operably coupled to another type of scanner,such as a facial recognition or biometric (such as fingerprint, iris,etc.) scanner such that the user must first use the scanner in order toaccess the interface.

Another set of embodiments disclosed herein relates to softwareapplications to provide feedback to a user relating to her/his surgicalperformance. The software applications can be used with a user interfacesuch as, for example, the user interface embodiments described above, oralternatively any processor or computer. Certain embodiments compareperformance parameters to standard benchmark performance parameters,while other embodiments track performance parameters over time.

In one embodiment, a software application is provided to track andcompare surgical tool endpoint positions. It is understood that during aprocedure, the surgical tool endpoint positions are indicative of theskill level of the surgeon. That is, an experienced surgeon will operatethe surgical tool with control and very little wasted motion. Incontrast, a novice will operate the tool with less control and morewasted motion. Similarly, the total distance traveled by a surgical toolendpoint can also be indicative of skill level. The shorter thedistance, the more experienced the surgeon.

According to one implementation, the software application tracks thetool endpoints and plots those tracks in a graph. For example, FIG. 18depicts two different graphs of endpoint positions tracked during an FLSpeg transfer test—the left graph depicts the endpoint track of anexperienced surgeon, while the right graph depicts the endpoint track ofa novice surgeon. Thus, such a graphical display qualitatively shows theexperience or skill level of a surgeon. Alternatively, the softwareapplication can track the tool endpoints and report information aboutthe total distance traveled or the total enclosed volume. In accordancewith one implementation, the software application can collect theinformation over time, thereby allowing for tracking of a surgeon'sprogress from a novice to a more experienced surgeon or to an expert.

In another embodiment, the software application records and tracks anyforces, velocities, and/or accelerations of any components of thesurgical tools. It is understood that very careful application of forcesand use of smooth motions need to be used during a surgical proceduredue to the enclosed and delicate nature of the operating site. Inaccordance with one implementation, the software application can beconfigured to limit the force, velocity, or acceleration of any devicecomponent during a procedure, thereby preventing the device fromexceeding any pre-established limits for those parameters. In a furtherembodiment or in combination with the parameter limits, the softwareapplication can also collect and record the parameter information andmake it available at a later time (such as post-surgery, for example),in some cases in combination with the surgical video, to identify anyspecific instances in which excess motion or force was used. Further, anoverall smoothness factor could be calculated by the softwareapplication using some combination of the parameters.

One embodiment of the software application utilizes any of the previousparameters to provide benchmark testing for surgeons. The parameter datacan be used to compare a surgeon's skills or the skills of groups ofsurgeons to other surgeons across the country or world. Alternatively,the software application can be used to test any individual surgeonagainst a known benchmark standard. In a further alternative, yearly orquarterly competency testing could be performed using the softwareapplication to certify that the surgeon meets or exceeds the setstandard.

In addition to benchmark testing, in one embodiment the same informationcan be used by the software application to monitor the state of asurgeon or user during a procedure. As an example, the system canmeasure any tremor by the surgeon during the procedure and compare it tothe surgeon's normal state as established based on information collectedduring past actual procedures or practice procedures.

In another software application embodiment relating to feedback, thesoftware is configured to provide warm-up or practice exercises for asurgeon, including providing such exercises just prior to performing anactual surgery. It has been shown that “warming up” prior to a surgicalprocedure improves the performance of a surgeon. In one embodiment, theuser console contains the software application and the applicationprovides a virtual reality environment for the user using the userconsole. The application can provide an example procedure in a virtualreality environment for the surgeon to perform that is similar to theactual procedure. Alternatively, the application can provide speciallydesigned warm-up tasks, procedures, “games,” or any other type ofwarm-up activity for the surgeon to perform prior to the actualprocedure.

It should be noted that any of the software application embodimentsrelating to feedback as described herein can be operated on any knownoperating system. For example, the software application can be used withany known user interface for a surgical system, any known controller forany surgical system, or any known processor or computer system. Incertain embodiments, a surgical device can be coupled to the userinterface or the computer, or alternatively, the user interface orcomputer can be used by the user to operate the software applicationwithout a surgical device coupled thereto. In yet another alternative, asurgeon at a remote training center could use a computer, controller, oruser interface that is linked to a robotic trainer or other type oftraining system at a central location to interface with the softwareapplication and perform tasks such as tests or warm-up procedures.

It should also be noted that the data relating to the various parametersdiscussed above can be collected using sensors coupled to the surgicaltools. Alternatively, the data can be provided by the controller basedon information already available from the controller. In a furtherembodiment, the data can be collected in any known fashion using anyknown devices.

Another set of embodiments disclosed herein relates to controllers orconsoles for use with various surgical systems, including roboticsurgical systems.

Certain controller or console implementations are configured to collectbiometric information relating to the user, including during use of thesystem for surgery or training. For example, in one embodiment as shownin FIG. 19, a console 300 is provided that is a known Da Vinci™ consoleor a similar controller. Alternatively, the console 300 can be any knowncontroller that can be used by a surgeon to operate a surgical deviceand that requires physical contact between the controller and thesurgeon. As shown, the console 300 has a viewer 302 that requires theuser (such as a surgeon) to place her or his head within the viewer 302in order to operate the console 300. This results in the head of theuser coming into contact with the viewer 302. Similarly, the console 300has an armrest 304 that allows the user to rest her or his arms whileusing the console 300. Like the viewer 302, the placement of the armrest304 results in the user's arms coming into contact with the armrest 304.In this implementation, the console 300 is provided with a sensor orsensors (not shown) associated with the viewer 302 and separately asensor or sensors (not shown) associated with the armrest 304. Theviewer sensor is configured to be in contact with the user's head whenthe user has correctly placed her/his head within the viewer 302, whilethe armrest sensor is configured to be in contact with the user's arm orarms when the user rests her/his arm or arms on the armrest 304. Thesesensors can be configured to collect various biometric informationregarding the user, such as, for example, temperature, breathingpatterns, pupil dilation, blinking (excessive blinking can indicateirritation or tiredness), muscle tension, and/or pulse rate.Alternatively, any other biometric information that can be indicative ofa user's physical state can be detected and/or collected. According toone embodiment, these metrics can be collected by the sensors and usedto track the user's physical state during a procedure.

According to one implementation, the information about the user'sphysical state can be used to modify the operation of the surgicalsystem. For example, in one implementation, any biometric informationindicating excessive stress or anger or the like can trigger the systemto automatically minimize, reduce, or shut down the movement of thecomponents of the surgical device. That is, any predetermined biometricparameter that exceeds a certain predetermined level can cause theprocessor to trigger the actuators on the surgical device to move at areduced speed, thereby slowing the movement of the device and reducingthe risk of injury to the patient. Further, if the biometric parameterexceeds a second, higher predetermined level, the processor triggers theactuators to stop entirely for a predetermined period, thereby forcingthe user to take a short break from the procedure. Alternatively, atthis higher level, the processor can be triggered to disconnect thecontrols from the device for a predetermined period, thereby producingthe same result of forcing the user to take a short break.

In accordance with certain alternative embodiments, the console 300 canbe linked to a robotic trainer or other type of training system tointerface with a software application similar to one of the applicationsdescribed above, thereby allowing a user to perform tasks such as tests,warm-up procedures, or surgical simulations while the console 300collects biometric information as described above, thereby allowing forevaluation of the physical state of the user during the simulation ortask.

In another controller embodiment as shown in FIG. 20, a controllersystem 310 is provided that is an open air controller system 310. Asused herein, “open air controller” means a controller that allows a userto control a device or system via movement of the user's arms, legs, andbody by taking a significant amount of position and orientationmeasurements via non-mechanical means. Commercial examples of open aircontrollers include the Wii and XBox Kinect gaming systems. Thecontroller system 310 depicted in FIG. 20 has a monitor 312 configuredto display a live video image of the surgical space as captured by oneor more cameras associated with the surgical device being used in theprocedure. Alternatively, instead of the monitor 312, the system 310could have a “heads up” display (not shown) that is worn on the head ofthe user.

The system 310 also has at least one of the following: one or morehandles 314 to be held and manipulated by the user and/or a trackingdevice 316 coupled with or positioned near the monitor 312. For system310 embodiments having one or more handles 314, the handles 314 can beused to control the surgical device, including the position andorientation of one or more end effectors on the device. These handles314 work as an electronic means of sensing position and orientation viawireless positioning, accelerometers, gyros, and/or compasses. Acommercial example of such a handle is the Wii controller. In oneimplementation, the handles 314 work in conjunction with the trackingdevice 316 to control the surgical device using handle tracking in whichthe tracking device 316 is configured to track identifiable markersassociated with each handle 314 and thereby be capable of tracking theposition and orientation of each handle 314 and use that information tocontrol the surgical device.

According to one implementation, the handle or handles 314 can also haveadditional components or features incorporated therein. For example, onehandle 314 embodiment can have at least one button or other inputcomponent that can be used to allow the user to interact with the systemvia menus displayed on the monitor 312 or in any other fashion in whichthe user can communicate with the system via an input component. In oneembodiment, the input component can be a button, a scroll wheel, a knob,or any other such component. Alternatively, the handle 314 can have asensor or any other type of detection component. In use, the user coulduse the input component or detection component to provide fineadjustments to the system or otherwise communicate with the system asdesired or needed.

Alternatively, the system has a tracking device 316 and no handles. Insuch an embodiment, the tracking device 316 tracks the location andmovement of the user's arms and/or hands in a fashion similar to thetracking of the handles as described above, but without the use of anyidentifiable markers. Instead, the tracking device 316 uses the arms,hands, or other relevant body parts as natural markers. In oneimplementation, the tracking device 316 is a camera that can be used toidentify and track the user or at least the hands and/or arms of theuser. According to one embodiment, the tracking device 316 can fully mapthe user's body such that positional information about various parts ofthe user's body could be used to control a surgical device. For example,the positional information about the user's elbows might be used tocontrol the surgical device. One commercial example of such a trackingdevice is the Kinect system used with the XBox gaming system.

Another similar embodiment relates to a tracking device 316 used inconjunction with a cuff or other type of device that is positionedaround at least a portion of the user's forearm. The cuff is configuredto detect and measure the firing of muscles in the forearm, such thatthe system can identify hand gestures. Other similar devices fordirectly measuring of muscle actions that are coupled to other parts ofthe user's body can also be used with the current system.

In another alternative embodiment, the system 310 is scaled to a smallersize such that the system 310 tracks a user's hands or fingers insteadof the user's arms or larger body parts. By tracking the user's hands,very fine motions can be used to control the surgical device. Such asystem would reduce the risk of fatigue.

In use, a user or surgeon can stand or sit or otherwise position herselfor himself in front of the monitor 312 so that the user can see thesurgical space as displayed on the monitor 312, including at least aportion of the surgical device. The user can then use either handles 314or the user's own arms and/or hands to make motions that will bedetected by the system 310 and utilized to control the movements of thesurgical device.

A similar embodiment relates to a system configured to control asurgical device based at least in part on eye motion. That is, a motionsensor or monitor—perhaps similar or identical to one of the trackingdevice embodiments described above—is positioned to track the motion ofa user's eye, and that motion can be utilized to control a surgicaldevice. In one implementation, eye motion tracking could help the systemrecognize the intended tooltip position by tracking where the user islooking.

Another controller embodiment relates to controller (not shown)configured to monitor brainwaves and thereby control a surgical devicebased on those brainwaves. In one specific embodiment, the controllerhas an electroencephalography (EEG) sensor that is positioned against oradjacent to the user's head. The EEG sensor senses electrical activityalong the scalp of the user and can be used to detect and therebyinterpret the brain waves of the user and use that information tocontrol the surgical device. In one implementation, such a systemeliminates the need for precise motor skills and relies instead on theuser's thoughts to actuate the surgical device.

In a further alternative, the EEG sensor could be used to monitor auser's mental state and work in combination with the system to react tothe information about the user's mental state in a fashion similar tothat described above with respect to monitoring a user's physical state.

In a further embodiment, the controller has a microphone that detectsvoice commands and the controller uses those commands to control thesurgical device. That is, the user can state verbal instructions thatthe controller detects via the microphone, and the software in thecontroller can be configured to analyze what the user said and triggerthe device to take the action instructed. One commercial embodiment of asimilar system is the Siri system used in Apple products. In use, theuser could use voice commands instead of physical manipulation tocontrol a surgical device. In one specific example, surgeons are oftenrequired to stop use of one component or device during a procedure toswitch to a different task. With this system, the surgeon could verballyinstruct the system to switch to the other task.

Another controller embodiment relates to various controller deviceshaving a foot controller. Some prior art controllers have footcontrollers made up of multiple foot pedals that require a user to useeach foot for more than one function and/or actuate more than one pedal.The foot controller embodiments herein are configured to reduce thefunctions, make those functions easier, or eliminate the multiplepedals.

FIG. 21 depicts a foot controller 320, according to one embodiment. Inthis embodiment, the controller 320 has one pedal 322. Having a singlepedal 322 eliminates the need for the user to release contact with thepedal 322 and make contact with one or more other pedals. In thisembodiment, the pedal 322 is a multi-directional pedal 322 that actslike a joystick for the user's foot. The pedal can be moved in any ofthe four cardinal directions to activate a different function inrelation to the surgical device or the surgical system.

Alternatively, the foot controller can be configured to have multiplefunctions that are selectable via a hand- or finger-actuated button orinput component. In one embodiment as shown in FIG. 22, the inputcomponent is a controller handle 330 with a scroll wheel 334, whereinthe scroll wheel 334 can be actuated to select the desired function of afoot controller (such as the foot controller 320). Alternatively, asshown in FIG. 23, the input component can be a basic mouse 340.Regardless of the specific input component, the component 330 or 340 isoperably coupled to the foot pedal (such as the foot controller 320discussed above) such that the input component 330 or 340 can be used toselect the function of the foot controller 320. In use, the user can useher or his hand to actuate the scroll wheel 332 of the handle 330 or thescroll wheel of the mouse 340 to select the appropriate function of thefoot pedal, such as the foot controller 320. In one embodiment, a menuis displayed on a display or monitor of the controller when the useractuates the scroll wheel and the user can then select from that menu.Of course, this menu can apply to one foot controller (like the footcontroller 320 above) or two different foot controllers or pedals.

In a further alternative, the controller has a pedal selection indicatorthat is displayed on the display. As an example, the pedal selectionindicator could be an overlay on a display such as the user interfacedisplay 286 discussed above with respect to FIG. 16A. Alternatively, theindicator could be displayed in any known fashion on any knowncontroller. In one embodiment, the pedal selection detecting device is acamera that is positioned to capture all of the one or more foot pedalsassociated with a foot controller. Alternatively, any sensor can be usedthat can detect which foot pedals are being used.

Returning to FIG. 22, the controller handle 330 can also be used tocontrol any part of a surgical device or system. The handle 330 has ahandle body 332, the scroll wheel 334, and two actuatable finger loops336A, 336B. The scroll wheel 334 and both finger loops 336A, 336B can beactuated by a user to trigger certain actions by the system or thesurgical device. One example of such an action relates to selection of afoot pedal function as described above, but many other actions can beaccomplished via the wheel 334 and loops 336A, 336B. In use, the usergrasps the handle body 332 and positions her or his hand such that thethumb and index finger can be positioned in the loops 336A, 336B and themiddle finger is in close proximity with the scroll wheel 334 such thatthe middle finger can be used to actuate the wheel 334 as needed. It isunderstood that this scroll wheel 334 operates in a fashion similar toknown scroll wheels, by providing both a scrolling action and a clickingaction.

Returning to the surgical device embodiments discussed above, anotherset of surgical device implementations relate to devices having at leastone biometric sensor associated with the device to monitor the status ofthe patient.

One example of a surgical device 350 embodiment having a biometricsensor 352 is set forth in FIG. 24. In this embodiment, the sensor 352is positioned in an arm 354 of the device 350. Alternatively, the sensor352 can be positioned anywhere else in or on the device 350. The sensor352 can be coupled to or with the existing electronics in the arm 354such that the sensor 352 is electrically coupled to an externalcontroller and thereby can provide feedback regarding one or morebiometric parameters. The various parameters can include, but arecertainly not limited to, temperature, pressure, or humidity. In use,the biometric parameter(s) of interest can be monitored by using thesensor 352 (or two or more sensors) to capture the relevant data andtransmit it to a controller that provides the information on a displayfor the user/surgeon to see.

Another set of embodiments relates to best practices in cavityinsufflations. It is understood that a patient's surgical cavity istypically expanded for purposes of a surgical procedure in that cavityby insufflating the cavity with a gas to maximize the amount of space inthe cavity while minimizing the risk of damaging the cavity wall ororgans by inadvertent contact with the surgical tools. The gas mostcommonly used is carbon dioxide (“CO₂”). One problem with the use of CO₂is the absorption of excess CO₂ into one or more tissues of the patient,which can cause or increase postoperative pain, including abdominal andshoulder pain. In one implementation, one method for maximizinginsufflation while minimizing the problems of CO₂ absorption involvesflushing the CO₂ from the patient's cavity at the completion of thesurgical procedure. More specifically, once the procedure is complete,another gas (other than CO₂) is pumped into the patient's cavity,thereby forcing or “flushing” the CO₂ out of the cavity. In accordancewith one implementation, the replacement or flushing gas can be a gasthat is more reactive than CO₂, because the reactive gas is used afterthe procedure is complete (when risks of using such reactive gas issignificantly reduced). In one embodiment, the replacement gas is oxygen(“O₂”). It is understood that the replacement gas is a gas that does notadversely affect the patient when the gas is absorbed.

EXAMPLE

One embodiment of a gross positioning system similar to those discussedabove and depicted in FIGS. 14A and 14B was examined. In this specificexample, the system was tested with a two armed surgical device with twoand three degrees of freedom per arm. The degrees of freedom of each armof the surgical device from proximal to distal tip were shoulder pitch,shoulder yaw, and elbow yaw. For the experiment, it was assumed the twoarms would work within close proximity of one another, as in a stretchand dissect operation.

The benchtop experiment took place in a mock surgical environment at theUniversity of Nebraska-Lincoln to show the advantages of the grosspositioning system over a fixed stand-alone device. The knownfundamentals of laparoscopic surgery (FLS) peg transfer task was used todemonstrate the dexterous workspace of the surgical device. The goal ofthis task was to touch the top of each peg.

The results of the benchtop testing with the gross positioning deviceshow that the gross positioning system is advantageous for surgicaldevices that typically would have poor dexterity or limited workspacewith such a positioning device. Without the positioning device, when allsix degrees of freedom were used, the stand-alone device could onlyreach a portion of the maximum number of pegs. In contrast, when thegross positioning system was used, all of the pegs were reachable withthe four and six DOF surgical devices. These benchtop results indicatethe advantages of a gross positioning system coupled with restrictedsurgical devices.

Although the present invention has been described with reference topreferred embodiments, persons skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention.

What is claimed is:
 1. A gross positioning system for use with a roboticsurgical device, the system comprising: (a) a body; (b) a first arm linkoperably coupled to the body at a first rotational joint; (c) a secondarm link operably coupled to the first arm link at a second rotationaljoint; and (d) an extendable third arm link operably coupled to thesecond arm link, wherein at least a portion of the third arm link isrotatable about a third rotational joint, wherein the third arm link isconfigured to be positionable through an incision in a patient, thethird arm link comprising a connection mechanism at a distal end of thethird arm link, wherein the connection mechanism is configured to becoupleable to the robotic surgical device, wherein at least two of anaxis of rotation of the first rotational joint, an axis of rotation ofthe second rotational joint, and an axis of rotation of the thirdrotational joint substantially intersect at a spherical joint.
 2. Thegross positioning system of claim 1, wherein the robotic surgical devicecomprises at least one arm, wherein the gross positioning system androbotic surgical device are configured to operate together to positionthe robotic surgical device within a body cavity of a patient.
 3. Thegross positioning system of claim 1, wherein the extendable third armlink comprises an extender body and an extendable rod slidably coupledto the extender body, wherein the extendable rod is configured to movebetween an extended position and a retracted position.
 4. The grosspositioning system of claim 1, wherein the spherical joint is disposedat the incision of the patient, wherein the third arm link is disposedthrough the spherical joint.
 5. The gross positioning system of claim 1,wherein the connection mechanism is positionable in a body cavity of thepatient.
 6. A gross positioning system for use with a robotic surgicaldevice, the system comprising: (a) a body; (b) a first arm link operablycoupled to the body at a first rotational joint; (c) a second arm linkoperably coupled to the first arm link at a second rotational joint; and(d) an extendable third arm link operably coupled to the second armlink, wherein at least a portion of the third arm link is rotatableabout a third rotational joint, wherein the third arm link is configuredto be positionable through an incision in a patient, the third arm linkcomprising a connection mechanism at a distal end of the third arm link,wherein the connection mechanism is configured to be coupleable to therobotic surgical device, wherein at least one of an axis of rotation ofthe first rotational joint, an axis of rotation of the second rotationaljoint, and an axis of rotation of the third rotational joint issubstantially perpendicular to at least one other of the axis ofrotation of the first rotational joint, the axis of rotation of thesecond rotational joint, and the axis of rotation of the thirdrotational joint.
 7. The gross positioning system of claim 6, whereinthe extendable third arm link comprises an extender body and anextendable rod slidably coupled to the extender body, wherein theextendable rod is configured to move between an extended position and aretracted position.
 8. The gross positioning system of claim 6, whereinthe connection mechanism is positionable in a body cavity of thepatient.
 9. The gross positioning system of claim 6, wherein at leasttwo of the axis of rotation of the first rotational joint, the axis ofrotation of the second rotational joint, and the axis of rotation of thethird rotational joint substantially intersect at a spherical joint. 10.The gross positioning system of claim 9, wherein the spherical joint isdisposed at the incision of the patient, wherein the third arm link isdisposed through the spherical joint.
 11. An external gross positioningsystem for use with an internal robotic surgical device, the systemcomprising: (a) a body; (b) a first arm link operably coupled to thebody at a first rotational joint; (c) a second arm link operably coupledto the first arm link at a second rotational joint; (d) an extendablethird arm link operably coupled to the second arm link, wherein at leasta portion of the third arm link is rotatable about a third rotationaljoint, the third arm link comprising a connection mechanism at a distalend of the third arm link, wherein the connection mechanism isconfigured to be coupleable to the robotic surgical device; and (e) aspherical joint disposed substantially at an intersection of at leasttwo of an axis of rotation of the first rotational joint, an axis ofrotation of the second rotational joint, and an axis of rotation of thethird rotational joint, wherein the spherical joint is disposedsubstantially at an insertion point of a patient, wherein the third armlink is disposed substantially through the spherical joint.
 12. Thegross positioning system of claim 11, wherein at least one of an axis ofrotation of the first rotational joint, an axis of rotation of thesecond rotational joint, and an axis of rotation of the third rotationaljoint is substantially perpendicular to at least one other of the axisof rotation of the first rotational joint, the axis of rotation of thesecond rotational joint, and the axis of rotation of the thirdrotational joint.
 13. The gross positioning system of claim 11, whereinthe extendable third arm link comprises an extender body and anextendable rod slidably coupled to the extender body, wherein theextendable rod is configured to move between an extended position and aretracted position.
 14. The gross positioning system of claim 11,wherein the connection mechanism is positionable in a body cavity of thepatient.
 15. A gross positioning system for use with a robotic surgicaldevice, the system comprising: (a) a body; (c) a first arm link operablycoupled to the body at a first rotational joint; (d) a second arm linkoperably coupled to the first arm link at a second rotational joint; (e)an extendable third arm link operably coupled to the second arm link,wherein at least a portion of the third arm link is rotatable about athird rotational joint, the third arm link comprising a connectionmechanism at a distal end of the third arm link; and (f) the roboticsurgical device operably coupled to the connection mechanism, therobotic surgical device comprising: (i) a device body; (ii) a first armoperably coupled to the device body, the first arm comprising at leastone first actuator; and iii) a second arm operably coupled to the devicebody, the second arm comprising at least one second actuator, wherein atleast two of an axis of rotation of the first rotational joint, an axisof rotation of the second rotational joint, and an axis of rotation ofthe third rotational joint substantially intersect at a spherical joint.16. The gross positioning system of claim 15, wherein at least one of anaxis of rotation of the first rotational joint, an axis of rotation ofthe second rotational joint, and an axis of rotation of the thirdrotational joint is substantially perpendicular to at least one other ofthe axis of rotation of the first rotational joint, the axis of rotationof the second rotational joint, and the axis of rotation of the thirdrotational joint.
 17. The gross positioning system of claim 15, whereinthe extendable third arm link comprises an extender body and anextendable rod slidably coupled to the extender body, wherein theextendable rod is configured to move between an extended position and aretracted position.
 18. The gross positioning system of claim 15,wherein the third arm link is configured to be positionable through anincision in a patient.
 19. The gross positioning system of claim 15,wherein the spherical joint is disposed substantially at an insertionpoint of a patient, wherein the third arm link is disposed substantiallythrough the spherical joint.
 20. The gross positioning system of claim15, wherein the connection mechanism is positionable in a body cavity ofthe patient.